Cervical Cancer Screening

About 75% of sexually active Albertans will get HPV in their lifetime.

Cervical cancer screening:
Pap tests can save your life.

Cancer is a scary word. But the good news with cervical cancer is that it can mostly be prevented with screening and follow-up care.

By having Pap tests regularly starting at age 25, or 3 years after becoming sexually active (whichever is later), you can detect any abnormal changes in the cells of the cervix – before they have a chance to become cancer. When abnormal changes are found early, they can be treated early, so you stay cancer-free.

What is a Pap test?

A Pap test (or what some used to call Pap smears) is a screening test that checks the cells of the cervix to make sure there are no abnormal changes. Abnormal cells can change over time and become cancer, without pain or symptoms. If any cell changes are found, they should be followed closely. If needed, they can be treated so that cancer does not develop.

Should you have a Pap test?

Having Pap tests is your choice. Starting at age 25, or 3 years after becoming sexually active (whichever is later), you should consider getting them as part of your regular health routine. Being sexually active means having any intimate skin-to-skin contact in the genital area. This includes touching, oral sex, or intercourse with a partner of either sex.

So for instance if you’re 17 and sexually active, you don’t need to start having Pap tests until you’re 25. And if you’re not sexually active until 25, you don’t need to start having Pap tests until you’re 28.

Cervical cancer develops over quite a long time, and it’s very rare in women younger than 25 years of age. That’s why even if you’re sexually active at a younger age, you can wait until 25 to begin having Pap tests. However, it’s always a good idea to talk with your healthcare provider about protecting yourself against sexually transmitted infections (STIs) and HPV – regardless of how old you are.

No matter what, if you’ve ever been sexually active, and haven’t had a Pap test, it’s never too late to start.

In certain circumstances, some women may feel they don’t need Pap tests. But you should still be screened for cervical cancer on a regular basis even if:

You feel perfectly healthy and have no symptoms of cervical cancer

You’re no longer sexually active

You’ve only had one sexual partner

You’re in a same-sex relationship

You’ve been through menopause

You have no family history of cervical cancer

You’ve had the HPV vaccine

Do you still need Pap tests if you’ve had a hysterectomy?

Continuing with Pap tests after a hysterectomy depends on your personal history:

If your hysterectomy wasn’t due to cervical cancer, you do not have a history of highly abnormal cells, and your healthcare provider is confident that the cervix has been totally removed, it’s okay to stop routine cervical cancer screening.

If you had a hysterectomy and you still have your cervix, it’s important to continue having regular Pap tests.

If you have had a hysterectomy because of cervical cancer or have had highly abnormal cells, your healthcare provider will likely want to continue doing tests of the area where your cervix was to make sure that none of the cells left behind become abnormal. This test is called a vault smear and is usually done every year.

If you have had a hysterectomy, talk to your healthcare provider about whether Pap tests or vault smears are needed.

Do you still need Pap tests if you've had cervical cancer?

Yes, for cervical cancer survivors, getting a Pap test annually is an important part of continued care following successful treatment of cervical cancer. Although many women diagnosed with cervical cancer will have their cervix removed, some may still have their cervix after radiation therapy, cone biopsy, or trachelectomy. Pap testing is still necessary, either of the cervix itself or of the place where the cervix used to be. This area is called the vaginal vault.

In Alberta, most women (81%) are alive and well five years after their cervical cancer diagnosis. Pap testing supports ongoing monitoring by enabling any changes to the cells in the area of the treatment to be found early, when they can be treated more successfully.

Following treatment for cervical cancer a woman should discuss her follow-up testing plan with the doctor who oversaw her treatment or who is now overseeing her care.

Preparing for your Pap test

Before your Pap test, here are a few things to keep in mind:

Try to make your appointment for a day when you won’t have your period (but if you have any abnormal bleeding, make an appointment with your healthcare provider right away).

Don’t douche or use contraceptive creams or jellies in the 24 hours before the test.

Don’t have sexual intercourse in the 24 hours before the test.

Avoid using personal lubricants in the 48 hours before the test.

How is a Pap test done?

The test is done right in your healthcare provider’s office and only takes a few minutes.

Your healthcare provider will gently insert an instrument called a speculum into your vagina so that the cervix can be seen. Your healthcare provider then collects a sample of cells to send to a lab to be checked.

Does it hurt?

Cervical screening only takes a few minutes, and while it might be slightly uncomfortable, it should not be painful. It may help to take a few deep breaths to relax yourself and reduce tension in your body.

It’s completely normal to feel a little nervous or unsure about having a Pap test. If you’re worried or uncomfortable, talk it over with your healthcare provider first and they’ll do their best to put you at ease.

Getting your results

After you’ve had your Pap test, the sample will be examined by the lab for any abnormal changes in the cells. There are a few different ways you may get your results:

You may hear from your healthcare provider.

You can always contact your healthcare provider if you don’t hear anything from them.

You’ll receive a result letter from the Alberta Cervical Cancer Screening Program (ACCSP)

What are the possible outcomes following my Cervical Cancer Screening?

In Alberta, cervical cancer screening is a Pap test followed by an HPV test if needed. There are three possible outcomes:

Your result is normal and you should continue with routine screening.

Your result is abnormal and you should follow-up with your healthcare provider so that changes in the cells of your cervix can be watched closely and treated, if needed. If you need follow-up, there’s one important thing to keep in mind: abnormal cells found through Pap tests are very rarely cancer. Abnormal cells can be monitored and treated if needed so that cancer does not develop.

Your result is unsatisfactory and you will be asked to repeat your Pap test again in 3 months. When this happens it most likely means that the lab could not read the sample because it did not have enough cells or the cells could not be seen under the microscope.

How often do you need to be tested?

After your first Pap test, plan to have a Pap test every 3 years. Annual screening offers very little extra protection compared to having Pap tests every 3 years. In fact, over-screening can lead to over-diagnosis of the cervical cell changes that would go away on their own – resulting in unnecessary follow-up testing.

After 69, most women can stop cervical cancer screening if their last 3 tests, done within the past 10 years, were normal and they didn’t have any serious abnormal changes in the past.

Talk to your healthcare provider about what’s right for you.

Be sure to always tell your healthcare provider if you experience any changes, such as bleeding between periods, after sexual intercourse or after menopause.

Benefits and risks of having Pap tests

As with any procedure, there are both risks and benefits to keep in mind. When it comes to cervical cancer screening, the biggest benefit is that it could save your life.

Benefits to being screened

90% of cervical cancer can be prevented by having Pap tests regularly.

Pap tests check for cervical cell changes caused by HPV, which can be followed closely to make sure they clear up. If needed, these abnormal cells can be treated so cervical cancer never develops.

Cervical cancer is rare in Alberta because many women have Pap tests regularly and are followed-up with by their healthcare providers when they have abnormal results.

Risks worth knowing about

There’s a chance the Pap test can miss abnormal cell changes, which is why it’s so important to be checked regularly. That’s also why it’s important to tell your healthcare provider right away if you have abnormal bleeding. This could include bleeding between periods, after sexual intercourse, or after menopause.

An abnormal result can be very stressful. Even though abnormal cells very rarely mean you have cancer, it can still be emotionally difficult to deal with.

Following-up on these changes may mean extra tests and more appointments, even though changes often go away on their own.

What causes an abnormal result?

Sometimes infections caused by bacteria or yeast can cause cells to look abnormal under a microscope. However, most often, abnormal Pap test results are caused by HPV.

What happens after an abnormal result?

No doubt, hearing that you have abnormal cervical cancer screening test results can be upsetting. But the most important thing you can do for yourself is go for follow-up appointments to find out if the cells have returned to normal or if they need to be treated so cancer doesn’t develop.

The next steps really depend on the type of abnormal results you have.

If you have low-grade (minor) cervical cell changes and your Pap test sample was not tested for high-risk HPV, your healthcare provider will repeat your Pap test in 6 to 12 months. Minor cell changes often go away on their own, and if your cells return to normal you won’t need treatment.

If you’re 30 years or older and the lab sees cell changes that are hard to read, your Pap test sample will be tested for high-risk HPV (HPV reflex testing). If HPV is found, your healthcare provider will refer you for a colposcopy. If HPV is not found, you won’t need any further tests until your next regular Pap test.

If you have low-grade (minor) cervical cell changes that don’t go away, OR if you have high-grade (moderate/severe) changes, your healthcare provider will likely refer you to a specialist (gynecologist) for a colposcopy to examine your cervix more closely.

What is HPV reflex testing?

If you’re 30 years or older and the lab sees cell changes in your Pap test that are hard to interpret, your Pap test sample will be tested for HPV. This is called HPV reflex testing. When women in this age group have high-risk HPV, their infections are more likely to be longer lasting. And longer lasting infections are what cause serious cell changes. Your healthcare provider will want the cells of the cervix looked at more closely.

If your HPV result shows that you don’t have HPV, you won’t need any further tests until your next regular Pap test. Your risk of developing cervical cancer over the next few years is about the same as women who have a normal Pap test result. If you do have HPV, it means the changes seen in your cervical cells were most likely caused by a high-risk HPV type. Your healthcare provider will refer you for a colposcopy. It is important to remember that having HPV doesn’t necessarily mean that you or your partner was unfaithful. The virus can hide in your body for years without any sign that it’s there. You or your partner may have been infected long before you became a couple.

What is a colposcopy?

A colposcopy is an exam that’s similar to a Pap test in some ways, but is done by a doctor that specializes in women’s reproductive health (a gynecologist).

The specialist will:

Insert a speculum into your vagina, and then put a mild vinegar solution on your cervix that will cause areas of abnormal cells to turn white.

Use a colposcope (a high-powered microscope) to look closely at any abnormal areas of your cervix.

You shouldn’t feel any extra discomfort during this procedure because the colposcope stays outside your vagina.

After a colposcopy

If an abnormal area is seen during the colposcopy, your specialist may decide to take a biopsy, or a tiny sample of cells, from the abnormal area.

There’s a chance you’ll feel some pinching or cramping, but the discomfort should go away quickly.

The biopsy sample will then be sent to a lab and examined under a microscope to help determine whether you need treatment.

If the colposcopist determines that you have:

low-grade cell changes, you’ll be followed closely to make sure the cells return to normal. You may have to have a repeat Pap test in several months or another colposcopy.

high-grade cell changes, treatment will be recommended so that cancer doesn’t develop.

When the abnormal changes have gone away on their own or have been treated, you will need to see your own healthcare provider for regular Pap testing:

if you had low-grade cell changes, you’ll need to have a Pap test every year for 3 years. If all 3 results are normal, you likely can start having Pap tests every 3 years.

If you had high-grade cell changes, your healthcare provider will likely advise you to keep having a Pap test every year to help ensure cervical cancer doesn’t develop.

The following is a detailed video taking you through what it means to get abnormal results. Although the video discusses having Pap tests every 2 years, Alberta guidelines recommend having a Pap test every 3 years for most women. From HPVInfoCanada.

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